Prognostic Factors in Adult Patients with Dengue: Developing Risk Scoring Models and Emphasizing Factors Associated with Death ≤7 Days after Illness Onset and ≤3 Days after Presentation

Lee, Ing-Kit; Huang, Chung‐Hao; Huang, Wen-Chi; Chen, Yi‐Chun; Tsai, Ching-Yen; Chang, Ko; Chen, Yen-Hsu

doi:10.3390/jcm7110396

Cited by 22 publications

(32 citation statements)

References 42 publications

(48 reference statements)

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“…138 Significant predictors for mortality include gastrointestinal bleeding <72 h after presentation, and haemoconcentration and leukocytosis after hospitalization. 139 Fluid resuscitation in pregnant women, small children, and those with co-morbidities need adapted fluid resuscitation and more frequent monitoring.…”

Section: Clinical Manifestations Of Severe Dengue and Managementmentioning

confidence: 99%

Severe dengue in travellers: pathogenesis, risk and clinical management

Halstead

Wilder‐Smith

2019

Journal of Travel Medicine

102

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Rationale for review Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue. Risk, pathogenesis and clinical management The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2–4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration. Conclusions Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.

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Section: Clinical Manifestations Of Severe Dengue and Managementmentioning

confidence: 99%

Severe dengue in travellers: pathogenesis, risk and clinical management

Halstead

Wilder‐Smith

2019

Journal of Travel Medicine

102

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“…In similar line, cough, fever, rashes, and headache were observed to be significantly less in fatal patients as compared with survivors. 15 Likewise, other signs and symptoms such as haemorrhagic manifestation, rash, leucopoenia, nausea/vomiting, ache, and pains and tardycardia were not observed to be significantly associated with ICU requirement. 13 Similarly, in a multiple logistic regression model, hematuria (OR 5.07) was observed to be significantly associated with death (OR 2.55).…”

Section: Discussionmentioning

confidence: 81%

“…13 Likewise, another study reported that patients with diabetes mellitus had a significantly higher risk (11.6; 95% CI: 1.3-1077) of ICU requirement compared with patients with no diabetes by Pang et al Additionally, patients who died had a significantly higher prevalence of diabetes along with hypertension and other comorbidities as compared to those who survived. 15 The duration of fever was significantly higher among those with ICU use, ventilator use and blood transfusion. Only some of the clinical features were significantly associated with the outcomes.…”

Section: Discussionmentioning

confidence: 92%

Association of clinical features, comorbidities and laboratory profile with outcomes among dengue patients admitted in a tertiary care hospital, Delhi NCR

Tiwari

Tibrewal²,

Pichika

et al. 2021

Int J Res Med Sci

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Background: Dengue fever is an endemic disease across multiple countries. Dengue infection results in a wide spectrum of non-specific clinical manifestations with unpredictable clinical course and outcome. Objective of the study was to understand the association of different clinical features, comorbidities and laboratory profile with outcomes (ICU use, ventilation use and blood transfusion) among dengue patients admitted in a tertiary care hospital in Delhi, National Capital Region.Methods This cross-sectional study included 75 dengue patients with fever <1 week confirmed based on NS-1 antigen and/or IgM antibody positivity. Descriptive analysis was used.Results: Gender was not significantly associated with the outcomes. The duration of fever was significantly higher among those with ICU use (median: 6 versus 4 days; p=0.005), ventilator use (median: 5.5 versus 4.0 days; p=0.049] and blood transfusion (median: 6 versus 4 days; p=0.013). Dengue patients with co-morbidities (diabetes, hypertension, or chronic obstructive pulmonary disease) or co-infection had a significantly higher odds of the outcomes. The platelet level was significantly lower while liver enzymes were significantly higher among those with the outcomes.Conclusions: The clinical features, comorbidities and laboratory profile can help in identifying critical patients for ICU admission and timely intervention to improve outcome.

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Section: Discussionmentioning

confidence: 99%

“…The massive loss of blood is rare in vascular leakage and shock (DHF/DSS), and, when present, it is largely restricted to the gastrointestinal tract ( 27 ). In general, the presence of DV in several organs is not associated with gross or microscopic evidence of severe organ pathology, which agrees with the pathogenesis of DHF/DSS ( 27 ). Similar organ tropism has been observed in the primate model, with high concentrations of the virus isolated from the skin and gastrointestinal tract, whereas low concentrations of the virus were recovered from the spleen, thymus, and several peripheral lymph nodes ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Mono-(2-ethylhexyl) phthalate Promotes Dengue Virus Infection by Decreasing IL-23-Mediated Antiviral Responses

et al. 2021

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Exposure to environmental hormones such as di(2-ethylhexyl) phthalate (DEHP) has become a critical human health issue globally. This study aimed to investigate the correlations between DEHP/mono-(2-ethylhexyl) phthalate (MEHP) levels and macrophage-associated immune responses and clinical manifestations in dengue virus (DV)-infected patients. Among 89 DV-infected patients, those with DV infection-related gastrointestinal (GI) bleeding (n = 13, 15% of patients) had significantly higher DEHP exposure than those without GI bleeding (n = 76, 85% of patients), which were 114.2 ng/ml versus 52.5 ng/ml ΣDEHP in urine; p = 0.023). In an in vitro study using cultured human monocyte-derived macrophages (MDMs) to investigate the effects of MEHP, treatment increased IL-1β and TNF-α release but decreased IL-23 release, with negative correlations observed between urine ΣDEHP and serum IL-23 levels in patients. MEHP-treated MDMs had lower antiviral Th17 response induction activity in mixed T-cell response tests. The in vitro data showed that MEHP increased DV viral load and decreased IL-23 release dose-dependently, and adding IL-23 to MEHP-exposed MDMs significantly reduced the DV viral load. MEHP also suppressed IL-23 expression via the peroxisome proliferator-activated receptor-gamma (PPAR-γ) pathway. Further, the PPAR-γ antagonist GW9662 significantly reversed MEHP-induced IL-23 suppression and reduced the DV viral load. These study findings help to explain the associations between high MEHP levels and the high global burden of dengue disease.

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Prognostic Factors in Adult Patients with Dengue: Developing Risk Scoring Models and Emphasizing Factors Associated with Death ≤7 Days after Illness Onset and ≤3 Days after Presentation

Cited by 22 publications

References 42 publications

Severe dengue in travellers: pathogenesis, risk and clinical management

Severe dengue in travellers: pathogenesis, risk and clinical management

Association of clinical features, comorbidities and laboratory profile with outcomes among dengue patients admitted in a tertiary care hospital, Delhi NCR

Mono-(2-ethylhexyl) phthalate Promotes Dengue Virus Infection by Decreasing IL-23-Mediated Antiviral Responses

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